| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
413 |
413 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
68 |
68 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
156 |
156 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
60 |
60 |
$4K |
| V2020 |
Frames, purchases |
199 |
199 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
245 |
245 |
$0.00 |